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Fiber in the Treatment and Maintenance of Inflammatory Bowel Disease: A Systematic Review of Randomized Controlled Trials

Wedlake, Linda MSc, RD*,†; Slack, Natalie MSc, RD; Andreyev, H. Jervoise N. PhD; Whelan, Kevin PhD, RD

doi: 10.1097/01.MIB.0000437984.92565.31
Clinical Review Articles

Background: Dietary fiber may favorably influence fermentation, gastrointestinal inflammation, and disease progression in Crohn's disease, ulcerative colitis (UC), and pouchitis and offer an attractive therapeutic addition to pharmacological treatment. This systematic review appraised data from randomized controlled trials of fiber in the management of inflammatory bowel disease.

Methods: The review followed Cochrane and PRISMA recommendations. Seven electronic databases were searched along with hand searching and contacting experts. Inclusion criteria were randomized controlled trials of the effects of fiber on clinical endpoints (primarily disease activity for treatment or maintenance) or physiological outcomes in patients with inflammatory bowel disease.

Results: In total, 23 randomized controlled trials fulfilled the inclusion criteria (UC, 10; Crohn's disease, 12; and pouchitis, 1) recruiting 1296 patients. In UC, 3/10 studies reported fiber supplementation to benefit disease outcomes. In Crohn's disease, 0/12 studies and in pouchitis 1/1 study reported a benefit on disease activity. Despite this, a number of studies reported favorable intragroup effects on physiological outcomes including fecal butyrate, fecal calprotectin, inflammatory cytokines, microbiota, and gastrointestinal symptom indices. Meta-analysis was not possible.

Conclusions: There is limited weak evidence for the efficacy of fiber in improving disease outcomes in UC and pouchitis. The potential antiinflammatory role of fiber is intriguing and merits further investigation in adequately powered clinical trials. Excluding overt gastrointestinal obstruction, there was no evidence that fiber intake should be restricted in patients with inflammatory bowel disease.

Article first published online 17 January 2014Supplemental Digital Content is Available in the Text.

*Department of Nutrition and Dietetics, The Royal Marsden NHS Foundation Trust, London, United Kingdom;

Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, United Kingdom; and

Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom.

Reprints: Kevin Whelan, PhD, RD, Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, 150 Stamford Street, London SE1 9NH, United Kingdom (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The systematic review was internally funded.

The authors have no conflicts of interest to disclose.

Received October 15, 2013

Accepted October 29, 2013

© Crohn's & Colitis Foundation of America, Inc.
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